Government opens less radical route for NHS devolution

The Cities and Local Government Devolution Bill was debated for the last time in the Lords on Tuesday and is now awaiting Royal Assent, which will make it law.

The Lords this week approved a new schedule to the bill which would enable a less radical version of devolution than the methods previously proposed.

The schedule amends the 2006 Health Act to enable NHS functions to be delegated to combined authorities, without a full transfer of responsibility needing to take place. Instead, functions such as the responsibility for commissioning a set of NHS services could be shared with a combined authority, but with clinical commissioning groups or NHS England remaining ultimately accountable.

As combined authorities are being newly created in law, in order to bring together devolved functions, existing rules do not allow NHS functions to be shared with them, or allow combined authorities to carry out public health functions.

The new section of the bill effectively gives local areas a new option for creating devolution arrangements, which goes further than current legislation allows, but is less extreme than fully transferring NHS functions to local authorities – as is still permitted under other parts of the bill, which were debated in parliament last year.

Introducing the changes, health minister Lord Prior told the Lords: “Crucially, wherever a responsibility for NHS functions is delegated or shared in this way, accountability would remain with the original function holder, whether that is NHS England or a clinical commissioning group. The original function holder would continue to be accountable via the existing mechanisms for oversight which ultimately go up to the secretary of state.”

Capsticks partner Sharon Lamb told HSJ this represented a “partial row back” from ministers, whom she said were now offering three options to local commissioners seeking to integrate health and social care via devolution: using existing powers; full transfers from the NHS to councils or combined authorities; and the new delegation and sharing arrangements approved this week.

King’s Fund senior policy adviser Helen McKenna said: ”Given there will be no formal transfer of powers to local or combined authorities [under the new section of the bill], this is about delegation rather than devolution. In practice, there will be little stopping NHS bodies from taking back control if local circumstances change.

“This ‘devo-lite’ approach is in line with the preferred parameters set out by NHS England.”

While full transfer of health functions to councils and combined authorities will still be permitted under the bill, a further new addition to the legislation will mean it will be possible for ministers to revoke these transfers.

Other amendments which were approved by the Lords on Tuesday clarify that the full extent of regulatory oversight for NHS functions – including those exercised by NHS England – will still apply in devolution areas, which ever of the three options are chosen.

During the Lords debate on Tuesday, Labour peer Lord Beecham said that during the early stages of the bill’s passage there had been little communication between health and local government departments in Whitehall.

He said: ”I think it became apparent to those of us who attended the meeting chaired by the noble Baroness [Williams, local government minister] at which the noble Lord, Lord Prior, was present, together with the silent presence of the minister for devolution and the northern powerhouse, that at that point there really had been virtually no contact between the relevant departments, notably the Department for Communities and Local Government and the Department of Health.”

However, he added: “Clearly matters have improved since then.”